Breakwater Psychiatry Inc.

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

BREAKWATER PSYCHIATRY INC.

Practice address

440 Humphrey St
Swampscott, MA 01907-2574

Phone

(781) 205-9496

NPI assigned

Feb 3, 2023

Last updated

Feb 3, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Megan Ann Cavanaugh, NURSE PRACTITIONERNPI 1093048605

Title

Owner

Phone

(781) 205-9496

Specialties & licenses 3

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Megan Ann Cavanaugh, RN

  • Adult Health Nurse Practitioner
  • Mashpee, MA
  • NPI 1093048605
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675382400000",
    "number": "1285330043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 PARADISE ROAD",
            "address_2": "VINNIN SQUARE PLAZA #1021",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "01970",
            "telephone_number": "781-205-9496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 HUMPHREY ST",
            "city": "SWAMPSCOTT",
            "state": "MA",
            "postal_code": "019072574",
            "telephone_number": "781-205-9496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKWATER PSYCHIATRY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-03",
        "last_updated": "2023-02-03",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "CAVANAUGH",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-205-9496",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "business@breakwaterpsychiatry.com",
            "affiliation": "N",
            "endpointDescription": "Business email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "440 Humphrey St",
            "city": "Swampscott",
            "state": "MA",
            "country_code": "US",
            "postal_code": "019072574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laura Juliana Boguslavskiy
• Carol Ann Bongiorno, LMHC
• Charla Larissa Bouranis, ME.D, ATC
• Mary A Boytim
• Lynne Bray
• Liana Bryanos Deloid, MS, RD, LDN
• Patricia Burden
• Kathleen Callahan Butt, PT ATC
• Michael J Cameron, PHD, BCBA
• Jessica Carey, DPT

• Health Service Clinic/Center in Swampscott, MA
• Providers in Swampscott, MA by specialty
• Health Service Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.